Major orbital complications of endoscopic sinus surgery

René, C; Rose, Geoffrey E.; Lenthall, Robert; Moseley, I. F.

doi:10.1136/bjo.85.5.598

Cited by 99 publications

(89 citation statements)

References 10 publications

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“…The lamina papyracea fractures readily follow blunt orbital trauma and is also readily breached in the course of ethmoid sinus surgery, exposing the orbit to the risk of inadvertent surgical injury. 3 The thick bone of the sphenoid body forms the most posterior part of the medial wall, adjoining the optic canal. The medial wall articulates with the roof at the fronto-ethmoid suture, which marks the upper limit of safe bone removal during medial wall decompression.…”

Section: Medial Wallmentioning

confidence: 99%

“…12 It is also susceptible to iatrogenic damage in ethmoid sinus surgery, when inadvertent orbital entry may occur. 3 The inferior rectus lies close to the floor posteriorly but has fat interposed anteriorly. In blow-out floor fractures, the inferior rectus may prolapse into the bony defect together with fat herniating into the maxillary antrum.…”

Section: The Extraocular Muscles and Their Nerve Supplymentioning

confidence: 99%

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Update on orbital anatomy

René

2006

Eye

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The orbit is a confined space bounded by four bony walls. Apart from the globe, orbital fat, and extraocular muscles it contains many important neurovascular structures. It is intimately related to the paranasal sinuses as well as the anterior and middle cranial fossae. Consequently, sinus pathology and intracranial disease may spread to involve the orbit and the converse applies. A thorough understanding of orbital anatomy is essential to fully appreciate the effects of disease on the orbit and is of paramount importance for performing safe orbital surgery. The anatomy of the orbit is discussed with reference to relevant orbital disease.

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Section: Medial Wallmentioning

confidence: 99%

Section: The Extraocular Muscles and Their Nerve Supplymentioning

confidence: 99%

Update on orbital anatomy

René

2006

Eye

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“…It is possible to inadvertently breach the orbital wall, specially the medial wall, using a powered instrument and to aspirate the contents of the orbit into the sinus through the breach. Diplopia along with motility restriction following FESS can occur either due to the entrapment of the muscle within the defect in the wall or due to the damage to the vascular or neural supply of the extraocular muscle [3,4].…”

Section: Discussionmentioning

confidence: 99%

“…Rene et al [3] have suggested that the eyes should be kept uncovered and monitored during FESS for any movement resulting from the traction on the orbital fat. If this is noticed, the surgeon should immediately stop the surgery.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Injury to Medial Rectus After Endoscopic Sinus Surgery

Mukherjee

Priyadarshini

Ramasubramanian

et al. 2015

Indian J Otolaryngol Head Neck Surg

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Endoscopic sinus surgery (ESS) is the mainstay of the treatment in sinus disorders, to re-establish the drainage of the affected sinus. The close proximity of the orbital structures to paranasal sinuses makes them vulnerable to inadvertent injury during the sinus surgery. Medial rectus (MR) muscle is the most commonly injured extraocular muscle during ESS due to its anatomic proximity to the thin medial wall of the orbit. This is a non-comparative, retrospective, interventional case series of six patients presenting with MR injury after ESS. We discuss the management, outcome and review the published literature. A total of six patients met the inclusion criteria. The presenting complaints were diplopia, squinting and limitation of ocular movements. Two patients underwent surgical exploration of the MR muscle and reattachment of the muscle along with injection botulinum to the antagonist lateral rectus muscle. Two patients who had small angle strabismus and who were able to fuse were advised orthoptic exercises and prisms as management. Remaining two patients were advised surgical intervention to correct strabismus but they declined further surgical intervention. Management of MR injury following ESS is complex, often resulting in suboptimal outcomes. Since early intervention is associated with better outcomes, early referral by otolaryngologists to ophthalmologists would result in better outcome.

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“…Among the damage to the EOM, damage to the medial rectus (MR), inferior rectus (IR) and superior oblique have been reported. The incidence of complications related to the MR, including muscle contusion, hematoma, the entrapment of bony defects, paralysis and transection, are most common 8,12-13,15-17…”

mentioning

confidence: 99%

Vertical Rectus Muscles Transposition in Large Exotropia with Medial Rectus Muscle Transection Following Endoscopic Sinus Surgery

Cho

Rah

Kim

et al. 2008

Korean J Ophthalmol

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PurposeTo evaluate the effect of transposition procedures on the vertical rectus muscle (VRM) in the patients who underwent a medial rectus muscle (MR) transection after endoscopic sinus surgery (ESS).MethodsIn 4 patients with exotropia (XT) and a lack of adduction after ESS, orbital CT or MRI revealed a complete transection of the midportion of the MR. Full-tendon VRM transposition was performed within 3 months after injury (early surgery) in 2 patients with 40Δ XT. Two patients with 70Δ and 85Δ XT underwent an X-type augmented Hümmelsheim procedure, which involved pulling each half-tendon and crossing it through the undersurface of the severed MR to the other end of the MR insertion, concurrently with an ipsilateral lateral rectus (LR) recession 11 months and 36 months after ESS, respectively. The adduction deficits were divided into -1 through to -8. The patients were followed up for more than than 1.5 years.ResultsPostoperatively, 3 patients showed orthophoria and no diplopia in the primary position. The adduction deficits improved to -3.5 or -4. One patient who underwent an X-type augmented Hümmelsheim procedure showed a residual XT of 25Δ.ConclusionsVRM transposition is effective in correcting a large XT secondary to a MR transection after ESS. When a longstanding large-angle XT with severe contracture of the ipsilateral LR and massive scarring of the adjacent tissues is present, the X-type augmented Hümmelsheim procedure coupled with an ipsilateral LR recession had an augmenting effect.

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Major orbital complications of endoscopic sinus surgery

Cited by 99 publications

References 10 publications

Update on orbital anatomy

Update on orbital anatomy

Iatrogenic Injury to Medial Rectus After Endoscopic Sinus Surgery

Vertical Rectus Muscles Transposition in Large Exotropia with Medial Rectus Muscle Transection Following Endoscopic Sinus Surgery

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